Judi Rx delivers transparent, member-focused PBM solutions, while Judi Care provides medical, vision, and dental benefits through Judi®, supporting millions of plan members across employers, unions, health systems, and government programs. Backed by General Catalyst.
About the role
Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider escalated inquiry management, subrogation, stop-loss, recoupment and adjustment flows, and adhering to standard and contractual claims processing SLAs.
What they're looking for
- Bachelors degree strongly preferred
- Experience managing a team of direct reports
- 1+ years of work experience at a health plan, claims adjudicator, or TPA
- Well-versed in Benefit determinations
- Well-versed in impact of claims processing and adjudication in regards to COB, Adjustments, Appeals, and member/provider inquiries
- Act as a patient advocate, protecting privacy and confidentiality issues
More about this role
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health .
Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform.
In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication...
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